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Palliative care medicines


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Palliative care medicines

  1. 1. Think Clinical ServicesPALLIATIVE CARE Last Updated: January 2009 1
  2. 2. What is Palliative Care?The goal of palliative care is to achieve the best possible quality of life for patients and their families and friends.Palliative care: - provides relief from pain and other distressing symptoms - affirms life and regards dying as a normal process - intends neither to hasten nor postpone death Think Clinical Services 2 2
  3. 3. What is Palliative Care?- offers a support system to help patients live as actively as possible- offers a support system to help the family and carers cope during the patient’s illness - avoids futile interventions.The patient should have a central role in decision-making. Think Clinical Services 3 3
  4. 4. PBS ListingA new and separate section has been introduced in the Schedule of Pharmaceutical Benefits for palliative care medications. For the purposes of prescribing under the Palliative Care Section of the PBS, a palliative care patient is defined as:a patient with an active, progressive, far-advanced disease for whom the prognosis is limited and the focus of care is the quality of life.Authority required for all palliative care listings(up to 4 months supply) Think Clinical Services 4 4
  5. 5. Palliative Care SectionThe Palliative Care Section adds to the medicines that were already available on the PBS (such as opioid analgesics) for use in patients typically with malignant neoplasia.The following medicines are listings in the Palliative Care Section: • Carmellose mouth spray (Aquae) as a saliva substitute. • Clonazepam 500 micrograms and 2 mg tablets (Paxam, Rivotril); 2.5 mg/mL oral liquid (Rivotril) for preventing epilepsy. Think Clinical Services 5 5
  6. 6. Palliative Care SectionNew Palliative Medicines.• Hyoscine butylbromide 20 mg/mL inj (Buscopan) for colicky pain.• Paracetamol 500 mg suppositories (Panadol) for analgesia.• Promethazine hydrochloride 10 mg and 25 mg tablets; 5 mg/5 mL elixir (Phenergan) for nausea and vomiting. 6
  7. 7. LaxativesA number of laxative products are included in the new Palliative Care Section. These include: • Bisacodyl 5 mg tablets and 10 mg in 5 mL enemas (Bisalax); 10 mg suppositories (Durolax, Fleet Laxative Suppositories, Petrus Bisacodyl Suppositories) • Docusate sodium with bisacodyl 100 mg/10 mg suppositories (Coloxyl) Think Clinical Services 7 7
  8. 8. LaxativesLaxatives• Glycerol suppositories 700 mg (for infants), 1.4 g (for children), 2.8 g (for adults) (Petrus)• Sorbitol, sodium citrate and sodium lauryl sulfoacetate enemas (Microlax)• Sterculia with frangula bark granules (Granocol, Normacol Plus). 8
  9. 9. AnalgesicsMany different analgesics are used in the management of pain. These may include:- Paracetamol- NSAIDs- Opioids- Adjuvants (control symptoms that may worsen pain) Think Clinical Services 9 9
  10. 10. FENTANYL PATCHES for Chronic PainSevere chronic pain– Oral morphine preferred Ease of dose adjustment Ease of availability– Reserve Fentanyl Use Cannot take oral morphine Vomiting or swallowing difficulty Severe renal impairment Think Clinical Services 10 10
  11. 11. FENTANYL PATCHES for Chronic PainCaution– Delayed onset of action– Prolonged duration of action– Opioid ADEs are difficult to control Monitor serious ADEs for 24 hrs after patch removal Serum concentrations ↓ slowlyEnsure safe disposal Think Clinical Services 11 11
  12. 12. Anticholinergic drugsHyoscine butylbromide is used to treat painful colic resulting from malignant bowel obstruction, and to reduce gastrointestinal secretions. It does not cross the blood–brain barrier so does not cause drowsiness or delirium. Its duration of action is less than 2 hours. It can be used subcutaneously.Belladonna alkaloids such as atropine have been used in palliating accumulated secretions and noisy breathing at the end of life. Think Clinical Services 12 12
  13. 13. AntiemeticsAntiemetics are often used prophylactically to counteract the emetic adverse effects of other drugs, especially opioids. However, care should be taken with this practice as all the commonly used antiemetics can themselves cause significant adverse effects.In the palliative setting, nausea and vomiting are common symptoms.Examples include: Metoclopramide (Maxolon, Pramin), Prochlorperazine (Stemetil), Domperidone (Motilium), Odansetron (Zofran) Think Clinical Services 13 13
  14. 14. Principles for managementKnow the person who is being treated and the impact that their illness is having on them.Know the disease that is being treated (reverse whatever can be reversed and treat symptoms simultaneously).Know the overall therapeutic aim of each intervention being introduced or ceased. Think Clinical Services 14 14
  15. 15. Principles for managementWork as a team, because it is unlikely that one person will have all of the solutions (and if you don’t have the answer to a particular problem, ensure that you involve the person who does); this includes working with subspecialists.Actively recognise periods of transition (rehabilitation, deterioration, terminal care). 15